MARK STEPHEN TRAVIS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****22

License Status

NOT RENEWED

Business

First Name

MARK

Middle

STEPHEN

Last Name

TRAVIS

Suffix

Business Name

MARK STEPHEN TRAVIS MD

Original Issue Date

11/04/2009

Effective Date

07/19/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60605

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

01/14/2021